Health care providers internationally are facing challenges surrounding the delivery of high quality, cost effective services. The use of integrated electronic information systems is seen by many people working in the health sector as a way to address some of the associated issues. In New Zealand the primary health care sector has been restructured to follow a population based care model and provides services through not-for-profit Primary Health Organisations (PHOs). PHOs, together with their District Health Boards (DHBs), contributing service providers, and local communities, are responsible for the care of their enrolled populations. The Ministry of Health (MoH) is streamlining information sharing in this environment through improvements to computer based information systems (IS). By providing health professionals with improved access to required information within an appropriate time frame, services can be targeted efficiently and effectively and patient health outcomes potentially improved. However, the adoption of IS in health care has been slower than in other industries. Therefore, a thorough knowledge of health care professionals’ attitudes to, and use of, available IS is currently needed to contribute to the development of appropriate systems. This research employs a multiple case study strategy to establish the usage of IS by three New Zealand PHOs and their member primary health care providers (PHPs), with a focus on the role of IS in clinical decision support (CDS). A mixed method approach including semi-structured interviews and postal surveys was used in the study. Firstly, the research develops and applies a survey tool based on an adaptation of an existing framework, for the study of IT sophistication in the organisations. This provides the foundation for an in-depth study of the use of computerised CDS (eCDS) in the PHO environment. Secondly, a conceptual model of eCDS utilisation is presented, illustrating the variation of eCDS use by member general practitioner (GP) practices within individual organisations. Thirdly, five areas of importance for improving eCDS utilisation within PHO’s are identified, contributing information of use to organisations, practitioners, planners, and systems developers. Lastly, the research provides a structure for the study of the domain of eCDS in PHOs by presenting a research approach and information specific for the area.

This dissertation presents the god-like interaction framework, consisting of tools and techniques for remote communication of situational and navigational information. The framework aims to facilitated intuitive and effective communication between a group of experts and remote field workers in the context of military, fire-fighting, and search and rescue.

Medication is vital in treating chronic disease. Increasing use of medication, however, can lead to (potentially preventable) medication-related adverse events. Medication management offers a means of addressing such adverse events and pharmacists have an important role in this solution, especially in terms of reviews of patient medication. Improved availability and sharing of patient-related information are critical factors in medication management, so that providing access to this information becomes a major factor in effective medication reviews. Although clinical decision support tools can significantly assist doctors in accessing relevant point-of-care information for greater patient safety, it has proven difficult to ensure the availability and appropriate structure of patient-related information for such support tools. These information access and input problems are further exacerbated by a lack of existing research into suitable decision support solutions for pharmacists. This research project explored the suitability of an essential information model to support an electronic document solution to support clinical documentation and allow effective communication between pharmacists and doctors for medication reviews. The project investigated whether this approach could improve safety, quality and efficiency in the medication review process; as well as more generally identifying factors influencing development and uptake of document-based support tools in the Health sector. The project used a qualitative Design Research approach and iterated through three scenarios. The first, information-rich, hospital scenario developed an information model of essential medication management components, which underpinned the development of a digital document prototype implemented using XForms technology. In the second scenario, accredited pharmacists evaluated the digital document to enable refinement of the information model and its associated digital document for the broader community context. The third scenario involved field studies which evaluated the digital document (and thus the underlying information model) within the community, assessing its contribution to quality, safety and efficiency throughout the medication review process. The investigation identified a number of themes which guided design and development of the prototype; and which appeared likely to have a broader impact on successful uptake of decision support tools. Missing information proved to be a constant and serious problem for health professionals although, in this project, it also became a way of determining the value of an information element and thus its inclusion in the information model. Conversation played a significant role in the hospital environment to help supply pharmacists information needs. Information granularity, the language of health professionals; and their time constraints were major factors influencing design. Health professionals extensive use of their personal knowledge also suggested decision support tools in this sector should be systems for experts rather than expert systems, i.e. the decision support tool and its users personal knowledge should complement one another. The results of this proof-of-concept project suggest practice improvement in medication management is possible, with perceived improvements in safety, quality and efficiency of the medication management process. These benefits, however, now need to be affirmed in larger field studies. The contributions of this research are two-fold: firstly, it is possible to develop a model of essential medication-related information which is succinct, relevant and can be understood and shared by health professionals in conjunction with the individuals personal knowledge. Secondly, a document metaphor is a natural fit with health professionals for representing and communicating information. Expressing this metaphor as digital document overcomes the main problems of paper-based documents sharing and communication; and the dynamic properties of digital documents assist in decision-making.

Complex Systems-of-Systems, which form the subject matter of the research presented here, may be considered to be systems that are constituted of several components, each of which could themself be regarded as being a complete system in its own right. These component systems are typically largely managed independently of one another. They each have their own intrinsic goals which they are capable of fulfilling autonomously. These goals are additional to any to which they might contribute as part of the overall System-of-Systems that is being investigated. Systems-of-Systems are epitomised by features such as the prevalence of complex webs of mutual interdependency amongst their component systems, the involvement of a broad diversity of stakeholders and the participation of a number of independent decision-makers, each of whom competes with the others for strictly limited resources. Furthermore, the components of Systems-of-Systems may often be found to be widely scattered across an extensive geographical region. Sometimes such systems may even span global distances. Complex Systems-of-Systems of such a nature would appear to be becoming ever more prevalent in the increasingly interconnected and ever shrinking world which is engendered, in particular, by the proliferation of modern information and communication technology. Systems-of-Systems may arise in both commercial and public sector contexts, hence commercial organisations and governments, alike, confront the daunting challenge of planning, establishing and maintaining novel systems of this type. However, it is to be anticipated that significant difficulties might be encountered in applying existing systems engineering methods, which were designed for dealing with far more monolithic types of system, to the treatment of Systems-of- Systems. Instead, the successful achievement of acceptable resolutions to the various Systems-of-Systems issues and conundrums with which the responsible planners can be expected to be confronted would appear to demand the application of sophisticated distributed decision aids, in order to alleviate the the intolerable burden which the decision-makers would otherwise be forced to endure. Such aids need to be able to take a genuinely fair and unbiased account of the interests of a multitude of stakeholders. At the same time, they must be able to satisfactorily accommodate the enforcement of a range of highly involved and intricate constraints upon the various alternative interventions which might potentially be contemplated. In order to underpin the development of decision aids of the kind demanded, it has been sought to establish some basic theoretical foundations for Systems-of-Systems. This body of theory has then been applied to the identification of the methods which might be most suitable for the treatment of Systems-of-Systems questions. Finally, some decision-support tools which are intended to facilitate the implementation of the methods that have been recommended have been described. Any attempt to dictate a single â??bestâ?? intervention to the decision-makers would generally be totally unacceptable. As a result, the objective which has been pursued has been to seek to filter out and identify a relatively sparing number of what would appear to be the most reasonable alternatives from some much more profuse range of possibilities. These may then be afforded more intensive scrutiny by the pertinent decision-makers.

This research was to develop a real-time, modifiable, tangible interactive tabletop system for participatory urban design. The targeting user group was those stakeholders in urban design charrettes. Previous system solutions overlooked the importance of the modifiable tangible medium in the situation of reaching spatial-temporal consensus. These design issues impeded communication between the stakeholders and the professionals. Users of these systems had difficulties expressing ideas to professionals during the collaborative design process. Literature in evolving technology in the smart city context, collaborative urban design, embodied interaction, and depth-sensing was referred to guide the system design. Based on the review, this research identified the pivotal role of a shapeable and tangible medium in the system. The prototype system unified the modifiable, realistic model with its digital equivalent in urban analytics in real-time. By integrating tangible interaction, depth-sensing, and large touch screen tabletop, an intuitive, immersive decision-making interface for non-professional stakeholders could be created. During the system implementation, system elements centering ‘tangible interoperability’ were documented along the system pipeline. A heuristic evaluation, a method of usability inspection, was conducted to assess and to guide the future system design. The result was promising and inspiring. In the end, challenges and directions of system design were discussed. The contribution of this research included: discovering direction, centering tangibility, implementing a prototype, and documenting elements in each stage along the system pipeline of designing a modifiable tangible interactive tabletop system for the urban design charrette.

<div>This thesis combines human and machine intelligence for consensus decision-making, and it contains four interrelated research areas. Before presenting the four research areas, this thesis presents a literature review on decision-making using two criteria: trust and risk. The analysis involves studying the individual and the multi-stakeholder decision-making. Also, it explores the relationship between trust and risk to provide insight on how to apply them when making any decision. This thesis presents a grouping procedure of the existing trust-based multi-stakeholder decision-making schemes by considering the group decision-making process and models. In the first research area, this thesis presents the foundation of building multi-stakeholder consensus decision-making (MSCDM). This thesis describes trust-based multi-stakeholder decision-making for water allocation to help the participants select a solution that comes from the best model. Several criteria are involved when deciding on a solution such as trust, damage, and benefit. This thesis considers Jain's fairness index as an indicator of reaching balance or equality for the stakeholder's needs. The preferred scenario is when having a high trust, low damages and high benefits. The worst scenario involves having low trust, high damage, and low benefit. The model is dynamic by adapting to the changes over time. The decision to select is the solution that is fair for almost everyone. In the second research area, this thesis presents a MSCDM, which is a generic framework that coordinates the decision-making rounds among stakeholders based on their influence toward each other, as represented by the trust relationship among them. This thesis describes the MSCDM framework that helps to find a decision the stakeholders can agree upon. Reaching a consensus decision might require several rounds where stakeholders negotiate by rating each other. This thesis presents the results of implementing MSCDM and evaluates the effect of trust on the consensus achievement and the reduction in the number of rounds needed to reach the final decision. This thesis presents Rating Convergence in the implemented MSCDM framework, and such convergence is a result of changes in the stakeholders' rating behavior in each round. This thesis evaluates the effect of trust on the rating changes by measuring the distance of the choices made by the stakeholders. Trust is useful in decreasing the distances. In the third research area, this thesis presents Rating Convergence in the implemented MSCDM framework, and such convergence is a result of changes in stakeholders' rating behavior in each round. This thesis evaluates the effect of trust on the rating changes by measuring the perturbation in the rating matrix. Trust is useful in increasing the rating matrix perturbation. Such perturbation helps to decrease the number of rounds. Therefore, trust helps to increase the speed of agreeing upon the same decision through the influence. In the fourth research area, this thesis presents Rating Aggregation operators in the implemented MSCDM framework. This thesis addresses the need for aggregating the stakeholders' ratings while they negotiate on the round of decisions to compute the consensus achievement. This thesis presents four aggregation operators: weighted sum (WS), weighted product (WP), weighted product similarity measure (WPSM), and weighted exponent similarity measure (WESM). This thesis studies the performance of those aggregation operators in terms of consensus achievement and the number of rounds needed. The consensus threshold controls the performance of these operators. The contribution of this thesis lays the foundation for developing a framework for MSCDM that facilitates reaching the consensus decision by accounting for the stakeholders' influences toward one another. Trust represents the influence.</div>

In the last few years the demand for organic products has increased rapidly resulting in a strong growth of the organic industry worldwide. Organic certification is globally used to guarantee that 'organic' labelled produce follow the principles and standards of organic agriculture set by international and national organic certification bodies. Currently the lengthy and complex process of organic certification is entirely paper based and requires multiple access by organic primary producers to the certifying body involving precise data capture and transfer over a long period of time. The paper based organic certification has some significant disadvantages such as being time-consuming, error-prone (in particular transcription errors) and complex. Any improvement of the paper based organic certification process can lead to higher efficiency, lower costs and time savings for primary producers and certifying bodies. Australia is a major supplier of organic produce holding almost half of the organic farmland worldwide. However, Australia?s unique geography provides challenges by means of huge distances and poor rural telecommunication coverage for the sustainable agriculture sector. The disadvantages of the paper based organic certification are this kind of environment more severe. Up until now, there has not been a software solution supporting organic primary producers in their certification process, let alone a mobile software solution. In any case there are many farm management software solutions available but they do not take into account the specific issues in organic agriculture such as soil management, pest control, or fertilisation of land/animals. The Mobile Organic Certification (MobiCert) project was created to overcome these disadvantages focussing on the development of a mobile information portal which can be accessed through mobile Internet using GPRS or 3G technology enabling primary producers access and provision to organic certification related information in field using their mobile phones. The MobiCert project investigates the effectiveness of mobile devices (mobile phones/PDAs) for (some of) the stages of the computerised organic certification, in particular in terms of information access and provision. Designed as a proof-of-concept project the investigation takes place in South Australia targeting the NASAA organic certified primary producers there. The MobiCert project is a pilot project within the SAmCom (Sustainable Agriculture m-Commerce) project framework, which aims to enhance the information access and provision for primary producers through m-Commerce. It is a joint project of the University of South Australia, m.Net, NASAA, e-Cert and the Fraunhofer Institute Using a qualitative approach in a rapid appraisal case study the goals of the MobiCert project are: to create a theoretical model (RuTADIM) for the mobile technology acceptance and diffusion of innovation in remote and rural areas; and to develop and test a prototype mobile information community for organic certification which provides access to data and information related to organic certification, (online and offline) record keeping functionalities, as well as community functionalities for communication and experience exchange of primary producers. The results of the proof-of-concept MobiCert project suggest that organic primary producers can benefit from a mobile information platform to access and provide information in rural and remote areas. The high acceptance of organic primary producer to use the mobile information community indicates the willingness to embrace new technology and solutions in the existing organic certification process. The benefits and acceptance of the MobiCert solution have to bee affirmed in follow on field studies incorporating other issues such as the underlying business models. The contributions of the MobiCert project are two-fold: firstly, it provides a theoretical model (RuTADIM) which gives insights of key influence factors for the acceptance of mobile technology and the diffusion of innovation in rural and remote areas. The RuTADIM model can be foundation for future research projects involving mobile technology rural and remote areas. Secondly, the MobiCert information community displayed the potential of mobile solutions for primary producers in remote and rural areas. The MobiCert platform is a stepping stone for future mobile solution which can build upon this platform.

Safety of the airborne platforms rests heavily on the way they are maintained. This maintenance includes repairs and testing, to reduce platform down time. Maintenance is performed using generic and specific test equipment within the existing maintenance management system (MMS). This thesis reports the work undertaken to improve maintainability and availability of avionics systems using an intelligent decision support system (IDSS). In order to understand the shortcomings of the existing system, the prevalent practices and methodologies are researched. This research thesis reports the development and implementation of an IDSS and the significant improvements made by this IDSS by integrating autonomous and independent information sources by employing a multi-agent system (MAS). Data mining techniques and intelligence agents (IA) are employed to create an expert system. The developed IDSS successfully demonstrates its ability to integrate and collate the available information and convert into valuable knowledge. Using this knowledge, the IDSS is able to generate interpreted alerts, warnings and recommendations thereby reasonably improving platform maintainability and availability. All facets of integrated logistics support (ILS) are considered to create a holistic picture. As the system ages, the IDSS also matures to assist managers and maintainers in making informed decisions about the platform, the unit under test (UUT) and even the environment that supports the platform.

A Geographic Information System visually communicates both spatial and temporal analyses and has been available for at least twenty years in New Zealand. Using a Kaupapa Māori Research framework, this research investigates the benefits and barriers for Māori if they were to adopt GIS to assist their development outcomes. Internationally, indigenous peoples who have adopted GIS have reported they have derived significant cultural development benefits, including the preservation and continuity of traditional knowledge and culture. As Māori development continues to expand in an increasing array of corporate, scientific, management and cultural arenas, the level of intensity required to keep abreast of developments has also expanded. GIS has been used by some roopū to assist their contemporary Māori development opportunities; has been suggested as a cost effective method for spatial research for Waitangi Tribunal claims; has supported and facilitated complex textual and oral evidence, and has also been used to assist negotiation and empowerment at both central and local government level. While many successful uses are attributed to GIS projects, there are also precautionary calls made from practitioners regarding the obstacles they have encountered. Overall, whilst traditional knowledge and contemporary technology has been beneficially fused together, in some instances hidden or unforeseen consequences have impeded or imperilled seamless uptake of this new technology. Challenges to the establishment of a GIS range from the theoretical (mapping cultural heritage) to the practical (access to data) to the pragmatic (costs and resources). The multiple issues inherent in mapping cultural heritage, indigenous cartography and, in particular, the current lack of intellectual property rights protection measures, are also potential barriers to successful, long-term integration of GIS into the tribal development matrix. The key impediments to GIS establishment identified by surveyed roopū were lack of information and human resources, and prioritisation over more critical factors affecting tangata whenua. Respondents also indicated they would utilise GIS if the infrastructure was in place and the cost of establishment decreased. Given the large amount of resources to be invested into GIS, and the opportunity to establish safe practices to ensure continuity of the GIS, it is prudent to make informed decisions prior to investment. As an applied piece of Kaupapa Māori research, a tangible outcome in the form of an establishment Guide is presented. Written in a deliberately novice-friendly manner, the Guide traverses fundamental issues surrounding the establishment of a GIS including investment costs and establishment processes.

Abstract Background Cardiovascular disease (CVD) has an enormous impact on the lives and health of New Zealanders. There is substantial epidemiological evidence that supports identifying people at high risk of CVD and treating them with lifestyle and drug-based interventions. If fully implemented, this targeted high risk approach could reduce future CVD events by over 50%. Recent studies have shown that a formal CVD risk assessment to the systematically identify high risk patients is rarely done in routine New Zealand general practice and audits of CVD risk management have shown large evidence-practice gaps. The CVD risk prediction score recommended by New Zealand guidelines for identifying high CVD risk patients was derived from the US Framingham Heart Study using data collected between the 1960s and 1980s. This score has only modest prediction accuracy and there are particular concerns about it’s validity for New Zealand sub-populations such as high risk ethnic groups or people with diabetes. Aims The overall aims of this thesis were to investigate the potential of a computerised decision support system (CDSS) to improve the assessment and management of CVD risk in New Zealand general practice while simultaneously developing a sustainable cohort study that could be used for validating and improving CVD risk prediction scores and related research. Methods An environmental scan of the New Zealand health care setting’s readiness to support a CDSS was conducted .The epidemiological evidence was reviewed to assess the effect of decision support systems on the quality of health care and the types and functionality of systems most likely to be successful. This was followed by a focused systematic review of randomised trials evaluating the impact of CDSS on CVD risk assessment and management practices and patient CVD outcomes in primary care. A web-based CDSS (PREDICT) was collaboratively developed. This rules-based provider-initiated system with audit and feedback and referral functionalities was fully integrated with general practice electronic medical records in a number of primary health organisations (PHOs). The evidence-based content was derived from national CVD and diabetes guidelines. When clinicians used PREDICT at the time of a consultation, treatment recommendations tailored to the patient’s CVD and diabetes risk profile were delivered to support decision-making within seconds. Simultaneously, the patient’s CVD risk profiles were securely stored on a central server. With PHO permission, anonymised patient data were linked via encrypted patient National Health Index numbers to national death and hospitalisation data. Three analytical studies using these data are described in this thesis. The first evaluated changes in GP risk assessment practice following implementation of PREDICT; the second investigated patterns of use of the CDSS by GPs and practice nurses; and the third describes the emerging PREDICT cohort and a preliminary validation of risk prediction scores. Results Given the rapid development of organised primary care since the 1990’s, the high degree of general practice computerisation and the New Zealand policy (health, informatics, privacy) environment, the introduction of a CDSS into the primary care setting was deemed feasible. The evidence for the impact of CDSS in general has been moderately favourable in terms of improving desired practice. Of the randomised trials of CDSS for assessing or managing CVD risk, about two-thirds reported improvements in provider processes and two-fifths reported some improvements in intermediate patient outcomes. No adverse effects were reported. Since 2002, the PREDICT CDSS has been implemented progressively in PHOs within Northland and the three Auckland regional District Health Board catchments, covering a population of 1.5 million. A before-after audit conducted in three large PHOs showed that CVD risk documentation increased four fold after the implementation of PREDICT. To date, the PREDICT dataset includes around 63,000 risk assessments conducted on a cohort of over 48,000 people by over 1000 general practitioners and practice nurses. This cohort has been followed from baseline for a median of 2.12 years. During that time 2655 people died or were hospitalised with a CVD event. Analyses showed that the original Framingham risk score was reasonably well calibrated overall but underestimated risk in high risk ethnic groups. Discrimination was only modest (AUC 0.701). An adjusted Framingham score, recommended by the New Zealand Guideline Group (NZGG) overestimated 5-year event rates by around 4-7%, in effect lowering the threshold for drug therapy to about 10% 5-year predicted CVD risk. The NZGG adjusted score (AUC 0.676) was less discriminating than the Framingham score and over-adjusted for high risk ethnic groups. For the cohort aged 30-74 years, the NZGG-recommended CVD risk management strategy identified almost half of the population as eligible for lifestyle management +/- drug therapy and this group generated 82% of all CVD events. In contrast the original Framingham score classified less than one-third of the cohort as eligible for individualised management and this group generated 71% of the events that occurred during follow-up. Implications This research project has demonstrated that a CDSS tool can be successfully implemented on a large scale in New Zealand general practice. It has assisted practitioners to improve the assessment and management of CVD at the time of patient consultation. Simultaneously, PREDICT has cost-effectively generated one of the largest cohorts of Māori and non-Māori ever assembled in New Zealand. As the cohort grows, new CVD risk prediction scores will be able to be developed for many New Zealand sub-populations. It will also provide clinicians and policy makers with the information needed to determine the trade-offs between the resources required to manage increasing proportions of the populations and the likely impact of management on preventing CVD events.